Basic Information
Provider Information
NPI: 1437357969
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: EADS
FirstName: JENNY
MiddleName: QUYNH
NamePrefix: MRS.
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: NGUYEN
OtherFirstName: JENNY
OtherMiddleName: QUYNH
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 224 HAILI ST STE B
Address2:  
City: HILO
State: HI
PostalCode: 967202975
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1178 KINOOLE ST
Address2:  
City: HILO
State: HI
PostalCode: 967207206
CountryCode: US
TelephoneNumber: 8089691427
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/05/2007
LastUpdateDate: 03/07/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X1361HIY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


Home